Working in A&E, I see many tragic cases, but one of the worst is the diagnosis of a young man with advanced and incurable bowel cancer. This used to be a rarity. Not now.
Not long ago I saw a farmer, in his 30s, who had gone to the emergency room at the insistence of his wife, who was worried that he was so exhausted.
I initially dismissed his symptoms as a result of being a new parent and the sleepless nights that entails. But he was pale, with a hint of yellow in the whites of his eyes. So, just in case, I did some blood tests, although I hoped they would be normal.
These revealed that he had extremely low levels of red blood cells and that his liver was not functioning properly, explaining the yellow tint in his eyes (caused by a buildup of bilirubin, produced when the liver breaks down red blood cells).
I sent him for an urgent CT scan and it showed he had stage 4 bowel cancer, which meant it had spread to the rest of his body. Two months later he died in a hospice.
When I was in medical school, I was taught that bowel cancer was something that only affected the elderly.
But in recent years, the number of young patients (under 50) with bowel cancer has skyrocketed, increasing by 2 percent each year since the 1990s. I see these patients in A&E, often because they have ignored the symptoms (cancer is not on your radar) until it is too late.
Just a few weeks ago, a college student came in because there was blood in her stool. She had also ignored her symptoms until, during an Internet search, ChatGPT correctly advised her to seek medical attention.
Dame Deborah James, also known as Bowelbabe, died of bowel cancer in 2022
Melissa Dunmore, from Melbourne, was diagnosed with stage three bowel cancer this year.
Without any obvious cause, such as piles, I urgently referred her for two weeks for tests for bowel cancer.
In the past, he probably wouldn’t have done it because of his age. But that has changed and I am very alert about bowel cancer.
What is driving this increase in cases? To try and find the answer, Cancer Research UK and the Bowelbabe Fund (set up by Dame Deborah James before she died of bowel cancer in 2022) have just launched a multi-million pound study. Over the next five years, researchers will look at all possible causes.
But those five years may be too late for some.
I have no doubt that the rapid rise in Europe and the United States points to environmental and lifestyle factors. For example, we now know that a diet high in ultra-processed foods and processed meats (and low in fiber) is a risk factor for bowel cancer. So is being overweight, smoking, alcohol and lack of exercise.
And research has suggested that environmental factors such as pesticides, plastics and air pollution could also be contributing.
But more recently, emerging evidence points to the role of our gut microbiome (the community of microbes found there) in protecting against bowel cancer. If you damage those microbes, you will have a higher risk of bowel cancer.
And yes, it’s not surprising that antibiotics are involved. A 2022 study published in the British Journal of Cancer compared rates of antibiotic use in cancer patients with people who were identical in every way except that they did not have cancer.
The number of young patients (under 50) with bowel cancer has increased by two percent each year since the 1990s.
The results showed that those under 50 were almost 50 per cent more likely to get bowel cancer if they had taken antibiotics. But in people over 50, antibiotic use was only associated with a 9 percent increased risk.
This is not necessarily proof that antibiotic use can increase the risk of bowel cancer, but it is eye-opening research with a good scientific explanation for what is happening.
Antibiotics reduce the levels of good bacteria that produce short-chain fatty acids (such as butyrate), which have anti-inflammatory and anti-cancer properties in the colon.
So why do antibiotics affect young people more?
We can’t be sure, but possibly your microbiome is more diverse, so the damaging effect of antibiotics is more pronounced. Additionally, there is increasing evidence that vaping has a detrimental effect on the gut.
A 2021 study in mice, published in the journal Environmental Science and Pollution Research, showed that vapor from e-cigarettes directly damaged the gut lining of mice, causing inflammation.
This is what predisposes you to developing bowel cancer. The good news is that four weeks after stopping it, the intestinal lining returned to normal.
As for what you can do now to protect yourself, my first choice would be to take steps to improve your gut microbiome.
That means eating more fiber and fewer ultra-processed foods, and trying to include fermented foods like kefir and sauerkraut in your diet.
I also think a daily probiotic supplement is a good idea; look for one that has at least 1 billion colony-forming units (or CFUs) per capsule.
There is evidence for this: A 2021 review of studies on the role of probiotics in cancer prevention, published in the journal Cancers, concluded: “There is much evidence that the use of probiotics can play an important role in the prevention and support for cancer. cancer therapies.’
As for my patients, while I was previously content to prescribe antibiotics quite liberally, I am now much more cautious and always tell them to take their prescriptions with probiotics, knowing that this advice will not harm them and may reduce their risks. of contracting bowel cancer.
@drobgalloway
New NHS league tables? Same old story
Last week, Health Secretary Wes Streeting announced plans to introduce league tables for hospital performance, including A&E waiting times.
External scrutiny is a good thing, but you have to be careful about the risk of unintended consequences, because we’ve been through this before.
When the last Labor government introduced the four-hour A&E target, many hospitals moved patients to a ward, not because it was in the best interests of the patients, but because it meant the hospital met the targets. In other words, ranking position was above patient care.
I’m also concerned about the impact on hospitals at the bottom of the table: it will damage the morale of staff who can make the necessary changes and make it harder to recruit the best people.
But my biggest concern is that a hospital’s waiting times actually reflect complicated problems beyond its control: in my ER we see patients quickly, but due to a lack of beds they can’t just go to the ward. That lack of beds
It is due to delays in discharge due to lack of community care, nothing to do with the hospital, which would be at the bottom of the table.
What we need is to improve health – and reduce the demand that is crippling the NHS – and these rankings will not help with that.